Abstract
Background
The aim of this study was to identify the role of median sternotomy in the hepatic
resection of large hepatocellular carcinomas (HCCs).
Methods
From 1992 to 2002, 26 patients who underwent hepatectomy for large HCCs greater than
10 cm in diameter were divided into 2 groups according to the type of incision performed:
with median sternotomy (10 patients) or without median sternotomy (16 patients).
Results
Median sternotomy was performed for 3 patients with tumor thrombus extending into
the right atrium and for 7 patients with inadequate exposure of the hepatic veins
and suprahepatic vena cava. In these 7 cases, the tumors were located mainly at the
upper part of the right lobe in 4 patients and the upper part of the left lobe in
3 patients. Median sternotomy was performed in 6 of 7 patients whose tumor was located
in segments 2, 4, 7, and 8, and was greater than 16 cm. No significant differences
were found in the intraoperative parameters of blood transfusion, ischemic time, area
of the cut surface, and operation time.
Conclusions
Median sternotomy may be suitable for use as an approach for large HCCs greater than
16 cm, which are located at the upper part of the liver.
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References
- The Brisbane 2000 terminology of Liver Anatomy and Resections.HPB. 2000; 2: 333-339
- A multiple regression equation for prediction of posthepatectomy liver failure.Ann Surg. 1984; 200: 658-663
- Median sternotomy extension of abdominal incision for hepatic lobectomy.Ann Surg. 1972; 175: 193-196
- Access to the abdomen.in: Dudley H. Rob C. Smith R. Operative Surgery. 3rd ed. Butterworth, London1997: 1-14
- Partial resection of the liver.in: Dudley H. Rob C. Smith R. Operative Surgery. 3rd ed. Butterworth, London1997: 308-319
- Optimal exposure for hepatobiliary operations using the Bookwalter self-retaining retractor.Am Surg. 1995; 61: 178-181
- Surgery for large primary liver cancer more than 10 cm in diameter.J Cancer Res Clin Oncol. 2003; 129: 543-548
- Selection criteria for hepatic resection in patient with large hepatocellular carcinoma larger than 10 cm in diameter.J Am Coll Surg. 2002; 194: 592-602
- Hepatic trisegmentectomy and other liver resections.Surg Gynecol Obstet. 1975; 141: 429-437
- The thoracoabdominal incision.in: Maingot R. Abdominal Operations. 6th ed. Prentice-Hall, Englewood Cliffs, NJ1974: 39-44
- An approach to intrapericardial inferior vena cava through the abdominal cavity, without median sternotomy, for total hepatic vascular exclusion.Hepatogastroenterology. 2001; 48: 1443-1446
- Extended subcostal hinge incision for right hepatic lobectomy.Am Surg. 1999; 65: 774-776
- Additional right parasternal incision without thoracotomy provides alternative access for hepatic resection.Am J Surg. 2003; 185: 155-157
- Anterior approach for major right hepatic resection for large hepatocellular carcinoma.Ann Surg. 2000; 232: 25-31
- Liver hanging maneuver: a safe approach to right hepatectomy without liver mobilization.J Am Coll Surg. 2001; 193: 109-111
- Mediastinal and sternal infections.Cardiac Surgery: State of the Art Review. 1988; 2: 407-414
- Treatment of infected median sternotomy wounds with a myocutaneous latissimus dorsi muscle flap.Scand Cardiovasc J. 1998; 32: 33-39
- A survey of 77 major infectious complications of median sternotomy: a review of 7,949 consecutive operative procedures.Ann Thorac Surg. 1985; 40: 214-223
- Primary treatment of the infected sternotomy wound with muscle flaps: a review of 211 consecutive cases.Plast Reconstr Surg. 1989; 84: 434-441
- Sternal wire-induced persistent chest pain: a possible hypersensitivity reaction.Ann Thorac Surg. 1990; 49: 135-136
- Median sternotomy.Surgery. 1993; 176: 615-624
Article info
Publication history
Accepted:
March 13,
2004
Yokohama, JapanIdentification
Copyright
© 2005 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
